Effect of oral stimulation in improving feeding performance of pre-term infants in NICU: A systematic review

Abstract

Aim: The Aim of this systematic review is to evaluate the effectiveness of oral stimulation techniques in improving feeding performance among pre-term infants in neonatal intensive care units (NICUs). Method: We conducted a comprehensive literature search of electronic databases, including PubMed, CINAHL, and Cochrane Library, from 2010-2021. Studies were included if they investigated the effect of oral stimulation on feeding performance outcomes such as time to full enteral feeding, weight gain, and length of hospital stay. Two reviewers independently assessed the quality of the studies using the Cochrane risk-of-bias tool and extracted data using a standardized data extraction form, and data were synthesized using a narrative approach due to heterogeneity in study design and outcome measures. Result: Our search identified 10 studies that met the inclusion criteria, consisting of randomized controlled trials, quasi-experimental studies, and case series. Eight studies reported significant improvements in feeding performance outcomes with the use of oral stimulation interventions compared to standard care or placebo. The remaining two studies reported mixed findings or no significant differences between groups. Overall, the quality of evidence was low to moderate due to methodological limitations and inconsistency in outcome reporting. Our findings suggest that oral stimulation techniques such as non-nutritive sucking, pacifier-activated device, and oral motor exercises are effective in improving feeding performance among pre-term infants in NICUs. These techniques were associated with reduced time to achieve full oral feeds, shortened hospital stay, and improved weight gain compared to control groups. Conclusion: The results of this systematic review suggest that oral stimulation may be an effective intervention for improving feeding performance in pre-term infants in NICUs. However, further research is needed to establish the optimal timing, frequency, and duration of oral stimulation interventions, as well as their long-term effects on growth and development. Future studies should also address methodological limitations, such as small sample sizes and lack of blinding, to improve the quality of evidence in this field. Significance of the study: Oral feeding is a difficult job for premature infants those who are admitted to NICU. Because of poor muscle tone, underdeveloped oral motor skills and reduced suck-swallow-breathe synchronization, they are unable to commence feeds from the bottle and breast immediately after birth, unlike full-term infants. As long as oral feeding is not developed, a number of non-oral feeding methods are employed which feeding methods can cause severe side effects 1. The primary barrier to oral feeding in infants with gestational age less than 34 weeks is the lack of coordination in sucking, swallowing, and breathing. Oral feeding in these infants can cause apnoea, decreased pulse oximetry, transient bradycardia, and aspiration. Therefore, in neonates those who do not reach the gestational age of 34 weeks for them bottle or breastfeeding are not considered, and developmental transition from gavage to oral feeding in a 28-week-old infant may take 6 weeks or longer. Several studies have shown that oral motor intervention on infants less than 34 weeks results in decreased transition time from gavage to oral feeding 2.